Ovarian Cyst Treatment
Evaluation and treatment of ovarian cysts based on their appearance, size, symptoms and persistence
What is ovarian cyst treatment?
An ovary makes a fluid-filled sac every month. A follicle grows, releases its egg and collapses, and the structure left behind fades away over a few weeks. Most cysts found on a scan are one of those caught in mid-cycle, and they need nothing but time.
A cyst becomes interesting when it does not follow that pattern. Some fill with old blood, some are lined with cells that keep producing fluid, and some are growths in their own right. The scan tells these apart by looking at the wall, at whether there are solid areas inside, and at how much blood is flowing through it.
Age changes the reading of the same picture. Before the menopause most cysts are part of the normal cycle. After it, the ovary should be quiet, so anything found there is looked at more carefully from the start.
What you might notice
- Pelvic pain
- Heaviness in the abdomen
- Irregular or painful periods
How it is diagnosed
A transvaginal ultrasound is the test that settles most of it. It measures the cyst, describes the inside and gives it a score for how likely it is to be simple, and a repeat scan six to twelve weeks later is often more useful than any single one, because resolution is itself the answer.
Blood tests are added according to age. CA-125 helps in a woman past the menopause and is much less reliable before it, since it rises with endometriosis, fibroids and even a chest infection. In a younger woman with a solid-looking cyst a different set of tumour markers is used.
A pregnancy test comes first in anyone of reproductive age. It changes the whole assessment, and it is quicker than a discussion about it.
Recovery
A cyst that is being watched asks nothing of you beyond turning up for the repeat scan.
Where it is removed through keyhole cuts, most women are home the same day or the next, sore around the small incisions and bloated for about a week from the gas used to lift the abdominal wall. Two weeks covers desk work, four covers most things. Where the abdomen has been opened for a large cyst, it is two to three nights in hospital and six weeks before heavy lifting.
The ovary itself recovers over about three months. Where the shell was peeled away and the rest of the ovary preserved, ovulation from that side usually resumes and fertility is generally unchanged.
If it is left untreated
Most cysts need no treatment, and watching one is a standard course and not a compromise. A simple cyst under 5cm in a woman still having periods is very likely to resolve on its own.
What can happen to a larger one is mechanical. A heavy cyst can twist the ovary on its stalk and cut off the blood supply, and that is a same-day emergency: without prompt surgery the ovary dies and is lost, which matters for future fertility in a young woman. A cyst can also burst or bleed into itself, which is sudden and painful but usually settles with rest and pain relief.
The other reason not to leave a complex cyst unexplained is that the scan features that make it complex are the ones that also flag an early ovarian cancer. Watching is for cysts that look simple; anything else gets an answer.
Questions about ovarian cyst treatment
Does an ovarian cyst always need surgery?
No, and most do not. A simple cyst under 5cm in a woman still having periods is very likely to be part of the normal cycle, and a repeat scan six to twelve weeks later usually shows it has gone. Surgery is considered where a cyst persists across two scans, where it is larger than about 5cm, where the ultrasound shows solid areas or thick walls, where it is causing pain, or where it is found after the menopause. Your doctor is essentially answering two questions with the scan: is it resolving on its own, and does it look like something other than a cycle cyst.
Will removing a cyst affect my chance of conceiving?
Usually very little. In a cystectomy the cyst wall is peeled away and the healthy ovarian tissue and its blood supply are left in place, and that ovary generally resumes ovulating within a few months. Some ovarian tissue is inevitably lost with the cyst, and it matters most where a woman has had repeated surgery on the same ovary or where the cysts are on both sides, so egg reserve is sometimes checked beforehand in a woman who has not yet completed her family. If a whole ovary has to be removed, a healthy ovary on the other side continues to release an egg and to make hormones, and conception is still entirely possible.
What does it mean if the scan calls a cyst complex?
Complex means the ultrasound shows more than clear fluid inside a thin wall. It might describe internal strands, a thickened wall, solid areas or increased blood flow. Most complex cysts are still benign, and the description fits several harmless things such as a cyst that has bled into itself, an endometriotic cyst or a dermoid. What the word does is close off watchful waiting as the answer, so a complex cyst gets further imaging, tumour markers appropriate to your age, and usually removal so the tissue can be examined properly.
Other obstetrics & gynaecology treatments
Delivery of a baby through surgery when vaginal delivery is not advisable or safe
InpatientManagement of non-cancerous growths in the uterus, based on symptoms, size, location and reproductive plans
Day CareTalk to a care coordinator about ovarian cyst treatment
Leave a number and a care coordinator calls you back with what the treatment involves and which hospital it would be at. They book a consult only if you want one